Dye diffusion during laparoscopic tubal patency tests may suggest a lymphatic contribution to dissemination in endometriosis: A prospective, observational study

Abstract

AimWomen with adenomyosis are at higher risk of endometriosis recurrence after surgery. This study was to assess if the lymphatic vessel network drained from the uterus to near organs where endometriosis foci lied.MethodsA prospective, observational study, Canadian Task Force Classification II-2, was conducted at Sacro Cuore Don Calabria Hospital, Negrar, Italy. 104 white women aged 18–43 years were enrolled consecutively for this study. All patients underwent laparoscopy for endometriosis and a tubal dye test was carried out.ResultsEvidence of dye dissemination through the uterine wall and outside the uterus was noted in 27 patients (26%) with adenomyosis as it permeated the uterine wall and a clear passage of the dye was shown in the pelvic lymphatic vessels regardless whether the tubes were unobstructed. Histological assessment of the uterine biopsies confirmed adenomyosis.ConclusionAdenomyosis is characterized by ectatic lymphatics that allow the drainage of intrauterine fluids (the dye and, perhaps, menstrual blood) at minimal intrauterine pressure from the uterine cavity though the lymphatic network to extrauterine organs. Certainly, this may not be the only explanation for endometriosis dissemination but the correlation between the routes of the dye drainage and location of endometriosis foci is highly suggestive.

Ultrasound Imaging of Abdominal Wall Endometriosis: A Pictorial Review

“…AWE is limited to the peritoneal surface and is the result of previous gynecological surgery [ 9 , 25 , 27 , 31 , 33 ]. Caesarean section represents the strongest risk factor for AWE considering the close contact that may commonly occur between endometrial cells and the subcutaneous tissue during this type of surgery [ 12 , 33 ]. Despite the already high incidence of AWE of about 0.8% in all women with a previous caesarean section, it is certainly underestimated [ 12 , 13 ].…”

“…Some authors have examined factors that contribute to Caesarean section endometriosis and have defined some possible causes, including: the easy separation and transport of endometrial cells by the flow of amniotic fluid into the pelvic cavity after hysterotomy; the large amount of endometrial cells spreading into the pelvis before hysterotomy closure, which can become trapped in the wound; and the nurturing role of blood and hormones after inoculation of the cells, allowing them to grow and develop in subcutaneous tissue [ 31 ]. It is important to highlight that a high incidence is reported after early hysterotomy (end of the second or beginning of the third trimester), as the early decidua seems to have more pluripotent capabilities, potentially resulting in enhanced cellular replication producing endometriosis [ 26 , 27 , 28 , 29 , 30 , 31 , 33 ]. AWE is often misdiagnosed with several other pathological conditions, such as hernias, hematomas, vascular anomalies desmoid tumors, lymphomas, metastatic carcinomas, Sister Mary Joseph nodules, and sarcomas [ 10 , 25 , 38 , 39 , 40 ].…”